Stroke: Vascular and Interventional Neurology (Mar 2023)

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns†

  • Piers Klein,
  • Ana Herning,
  • Brian Drumm,
  • Jean Raymond,
  • Mohamad Abdalkader,
  • James E. Siegler,
  • Yimin Chen,
  • Xiaochuan Huo,
  • Wouter J. Schonewille,
  • Xinfeng Liu,
  • Wei Hu,
  • Xunming Ji,
  • Bertrand Lapergue,
  • Chuanhui Li,
  • Fana Alemseged,
  • Daniel Strbian,
  • Urs Fischer,
  • Johannes Kaesmacher,
  • Hiroshi Yamagami,
  • Volker Puetz,
  • Simona Sacco,
  • Espen Saxhaug Kristoffersen,
  • Jelle Demeestere,
  • Kyriakos Lobotesis,
  • Dylan Roi,
  • Kubilay Aydin,
  • Francesco Diana,
  • Hesham E. Masoud,
  • Alice Ma,
  • Roberta Novakovic‐White,
  • Fawaz Al‐Mufti,
  • Yuyou Zhu,
  • Hongfei Sang,
  • Dapeng Sun,
  • Thang Huy Nguyen,
  • Mai Duy Ton,
  • Jean‐Christophe Gentric,
  • Jildaz Caroff,
  • Marios‐Nikos Psychogios,
  • Arturo Consoli,
  • Lukas Meyer,
  • Jens Fiehler,
  • Joey English,
  • Rishi Gupta,
  • Bernard Yan,
  • Bruce Campbell,
  • Ashutosh P. Jadhav,
  • Jin Soo Lee,
  • Götz Thomalla,
  • Simon Nagel,
  • Qingwu Yang,
  • Osama O. Zaidat,
  • Zhongming Qiu,
  • Zhongrong Miao,
  • Soma Banerjee,
  • Thanh N. Nguyen

DOI
https://doi.org/10.1161/SVIN.122.000642
Journal volume & issue
Vol. 3, no. 2

Abstract

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Background Two recent trials demonstrated a benefit for endovascular therapy (EVT) in the treatment of basilar artery occlusion (BAO). In light of the expected increase in the use of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists performing EVT for BAO. Methods We conducted an international online survey of physician opinions on the use of EVT in BAO between January and March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Responses from neurointerventionalists were analyzed. Results More than 3000 participants were invited yielding 1245 respondents, of whom 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the posterior cerebral artery, without regard for prior intravenous thrombolysis. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method of 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease etiology, combined stent retriever and aspiration thrombectomy was the preferred method of 40.5% of neurointerventionalists. The majority of neurointerventionalists (88.0%) would proceed to stenting after 3 or fewer failed passes for patients with BAO of intracranial atherosclerotic disease etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). Conclusions Among the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to intracranial atherosclerotic disease, the majority of neurointerventionalists were willing to stent and do so most often after 3 or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without intracranial atherosclerotic disease. Key Words

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